Lead poisoning is a condition caused by exposure to lead resulting in high blood lead levels. Lead is a metal that occurs naturally in the environment. Although it has many beneficial industrial uses, it is harmful to humans when ingested or inhaled. There is no safe level of lead in the body. It is particularly harmful to the developing brains and nervous systems of fetuses and young children. This is especially true during the critical development periods of early childhood. Young children are most vulnerable to the effects of lead because they absorb a greater percentage of lead as they quickly grow and develop.

Lead is highly toxic and is found in many products in and around the home. You cannot see, taste or smell lead, so it may be in your home environment without your knowledge. It is generally found in paint, dust or soil in or around older housing, particularly housing built before 1950 or between 1950 and 1978. However, there are other sources of lead exposure as well which could result in lead poisoning.

Blood lead levels are measured as micrograms of lead per deciliter of whole blood (µg/dL). Although there is no scientific evidence on a safe level of lead in the blood, the Centers for Disease Control and Prevention (CDC) has revised their reference level for children6-72 months of age at from 10µg/dL to 5µg/dL. The reference level refers to a blood lead level at which recommended specific interventions should be implemented to reduce the blood lead levels in the body.

Although lead is no longer used in paint, gasoline and many consumer products, some sources of lead still exist and thus pose a health hazard.

The most common risk factor for childhood lead poisoning is the deteriorating residential lead-based paint which is found in almost all housing units built prior to 1950, as well as lead contaminated dust and soil. Lead-based paint was banned for use in 1978, which means that all houses built before 1950 and many built between 1950 and 1978 may have lead-based paint. Children are most often poisoned when lead-contaminated dust gets on their hands or toys and is then transferred to their mouths. Sometimes children may actually eat paint chips or inhale leaded dust.

According to the CDC, deteriorated leaded paint and elevated levels of lead contaminated house dust are present in an estimated 24 million U.S. housing units. More than 4 million of these units are homes to one or more young children.

Lead in Water

Houses containing lead pipes or pipes soldered or welded together with metals containing lead, may have high lead levels in drinking water. According to the U.S. Environmental Protection Agency (EPA) homes built before 1986 are more likely to contain lead pipes, fixtures and solder. Lead enters tap water through corrosion of plumbing. Corrosion is a reaction between the water and the lead pipes or solder. Dissolved oxygen, low pH (acidity) and low mineral content in water are common causes of corrosion.

It is important to note that children can be exposed to lead hazards through “take home” sources. In other words, lead particles brought home on the clothes, shoes or hands of an adult who works in an occupation that exposes him/her to lead. At work, people are usually exposed by breathing in air that contains lead particles. Families of workers may be exposed to higher levels of lead when workers bring home lead dust on their work clothes and shoes.

Work that involves industrial painting (such as bridges, water towers), cable splicing, construction, mining, radiator repair, recovery of gold and silver, repair and reclamation of lead batteries, smelting, welding, working on firing ranges and oil fields, and manufacturing bullets, ceramic tiles, electrical components, and lead batteries, are some of the occupations where workers may be exposed to lead.

Children may also come in contact with lead and get lead poisoning through hobbies and leisure activities such as making stained glass, pottery, bullets and fishing sinkers, refinishing furniture and painting.

Lead in Toys

Children may be exposed to lead from toys that have been made in other countries and imported into the United States or from antique toys and collectibles passed down through generations. Lead may also be found in older toys made in the United States. The U.S. Consumer Protection Safety Commission (CPSC) is responsible for announcing recalls of toys which contain excessive levels of lead and could result in adverse health effects.

Recalled toys that show signs of wear (chipped or peeling paint) or have cracked or broken parts are of special concern.Children6-72 months of age are at the greatest risk from lead exposure and children under 36 months of age are particularly susceptible because of this age group's normal hand-to-mouth behaviors.

A complete list of all the recalled products can be found at the CPSC website. To subscribe to the CPSC's email distribution list to receive bulletins about recalled products, consumers can go HERE.

Certain traditional home health remedies contain lead. Greta and Azarcon are used by Hispanic communities to treat upset stomach or indigestion. Pay-loo-ah is used within the Hmong community and given to children as a cure for rash or fever. Certain Asian remedies are also found to contain lead such as Bali Goli, Ghasard, and Kandu.

Kohl (also known as Kajal or Surma) is used by Middle Eastern and South Asian communities.It is a traditional cosmetic used as an eyeliner, however, it contains high levels of lead.

Lead may also leach into food if it is put into improperly glazed pottery or ceramic ware made outside the United states (especially bean pots from Mexico).

Leaded Mini Blinds

In 1996, the CPSC issued a warning that some imported vinyl (plastic) mini blinds manufactured in China, Taiwan, Mexico, and Indonesia may present lead poisoning hazard for young children. Lead is used as a fixative in the vinyl. As the vinyl deteriorates when exposed to sunlight and heat, it forms lead dust on the surface of the blinds that children can get on their hands and then in their mouths. New mini blinds should always be in a box labelled "Lead Free." Some homes may still have leaded mini blinds installed prior to 1996.

Any recalled toy should be removed and returned to the manufacturer according to the instructions that are provided on the CPSC web site. Any toys that show signs of wear (chipped or peeling paint) or have cracked or broken parts are of special concern. Suspicious toys should be removed from the child's access immediately. A free e-mail subscription to the CPSC recall list is also available on their web site.

Consult with the child's primary healthcare provider for further assessment for blood lead testing. When assessing the child's need for blood lead testing, the provider should use the Lead Exposure Risk Assessment Questionnaire (LERAQ).

Avoid using home remedies (such as Greta, Azarcon, Pay-loo-ah) and cosmetics (such as Kohl, Surma) that contain lead.

Avoid using imported pottery (especially from Mexico) unless you are certain that they do not contain lead.

If you think your home has imported vinyl (plastic) mini blinds, replace them with new mini blinds that state on the packaging that they are "lead free."

Most children with elevated blood lead levels (EBLLs) have no obvious signs and symptoms. A blood test is the only sure way to know if your child has lead poisoning.

The Oklahoma Childhood Lead Poisoning Prevention Program (OCLPPP) recommends that health care providers assess all children at 12 and 24 months of age with the LERAQ to determine their need for blood lead testing. Any child, 6-72 months of age, should be assessed with the LERAQ if they have never been assessed before. If you (parent/guardian) answers “yes” or “don’t know” to any of the questions, your child should receive a blood lead test. Contact your health care provider to schedule an appointment for a blood lead test for your child. If needed, the OCLPPP can help you find a heath care provider who can test your child for lead exposure. Please view the LERAQ below to determine if your child should be tested.

The first test is a Screening test. Blood is taken from the finger. This is also called a capillary test. If the result of the capillary test is 5 µg/dL or greater of blood, then the child should receive a venous test (blood taken from the arm). This is called a Confirmatory Test.

5 μg/dL of lead in children’s blood is considered to be the reference level for intervention by the CDC. Recommendations from the CDC say that venous blood specimens are preferred for blood lead analysis. In Oklahoma, as well as in other states, an elevated blood lead level is confirmed with a venous blood test, not a finger stick.

Children 6-72 months of age who have a capillary blood lead level of 5 µg/dL or greater should receive a venous blood lead test within 3 months if the level is between 5-14; within 1 month if the level is between 15-19; and within 1 week if the level is greater than or equal to 20.

For a child with an elevated venous blood lead level of 5-19, follow-up blood testing should occur every three months. Venous testing continues until 2 consecutive venous tests at least 3 months apart are below 5 µg/dL. Please refer to the Management Guidelines to see how the OCLPPP currently recommends follow-up testing for children 6-72 months of age.

All Medicaid-enrolled children must be tested for lead exposure at 12 and 24 months of age as part of the Early Periodic Screening, Diagnosis and Treatment (EPSDT) services. Parents should remind their child's medicaid provider that a lead test is a required part of the EPSDT service to their child. For additional information about EPSDT services, visit the Oklahoma Health Care Authority - EPSDT page.